2015 hawaii yin baguazhang workshops registration yin ... winter reg form.pdf · hawaii wushu...
TRANSCRIPT
Hawaii Wushu CenterPresents
Yin Family Baguazhang
2015 Hawaii Yin Baguazhang Workshops Registration
Participant's Personal Information
Name
Address
Phone
State/Other
Country
Zip/Postal Code
www.yinbaguazhang.com www.hawaiiwushucenter.org
City
Age
Workshop SelectionCheck mark the workshops you would like to attend.
#1 Nov 7 #2 Nov 8
IDay
Day
#5 Nov 21 #6 Nov 22 #7 Dec 5 #8 Dec 6
Check BoxCheck BoxCheck BoxCheck Box
Check Box Check Box
#3 Nov 14 #4 Nov 15
Check Box Check Box
Registration Fees
Full Day #1 $150
Total Due
PaymentCheck (Payable to "Hawaii Wushu Center")Mail to address below
Credit Card
Card Number
Expiration Date (MM/YY)
Cardholder Name
Hawaii Wushu Center, 1707 Alencastre St., Honolulu, HI 96816 USA, Phone: 1 808 489 3921, Email: [email protected], Website: www.yinbaguazhang.com
Please contact us if you have any questions. We will mail or email you your registration confirmation.
Subtotal
Discount (calculate and input)
Input
Half Day #2 $ 75
Full Day #3 $150
Half Day #4 $ 75
Full Day #5 $150
Half Day #6 $ 75
Input
Input
Input
Input
Input
Discounts: All Days Discount = -$300 2 Full Days Discount = -$100 3 Full Days Discount = -$150 4 Full Days Discount = -$200Family discounts are available. Contact us for details.
To process a credit card by phone call (808) 457-5844
or
Card Security Code
Attend Everything for only $600
If youpaid online checkhere
Full Day #7 $150 Input
InputHalf Day #8 $ 75